Dr. Richard Madonna on HTN and why it is a risk factor for glaucoma

AdminWolf

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In this InSight Studio interview from SECO2019, we speak with Dr. Richard Madonna from SUNY Optometry, where he explains why hypertension is a risk factor for glaucoma. (surprisingly, the answer has part to do with hypotension!
 
Thanks again for Dr. Madonna for sitting down with us.

I appreciated his "tips" on modifying when the patients take their HTN meds to reduce the risk. The big question is can you get a cardiologist (or GP for that matter) to agree to adjust the patient's dosing schedule?
 
BTW, Dr. Madonna also has a course at CEwire2019 about systemic disease & optometry, if you haven't seen it yet, here's an excerpt:



You can watch the full show from now until July 1st at CEwire2019!

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Thanks again for Dr. Madonna for sitting down with us.

I appreciated his "tips" on modifying when the patients take their HTN meds to reduce the risk. The big question is can you get a cardiologist (or GP for that matter) to agree to adjust the patient's dosing schedule?
If you write a letter or call them with your concerns, I have found that they will do it.
 
New patient comes to your office. 55wm. He’s being treated for hypertension and reports it’s controlled well. BP in office is 120/80.

Cd is 0.3 OU.

Is this patient a glaucoma suspect?

If so....what tests do you order?
 
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New patient comes to your office. 55wm. He’s being treated for hypertension and reports it’s controlled well. BP in office is 120/80.

Cd is 0.3 OU.

Is this patient a glaucoma suspect?

If so....what tests do you order?
You have not told us enough to decide. What are the rim ratios? VDD? IOPs?

However, I tell my students there are two types of patients: glaucoma suspects, and glaucoma patients.
 
You have not told us enough to decide. What are the rim ratios? VDD? IOPs?

However, I tell my students there are two types of patients: glaucoma suspects, and glaucoma patients.

Let's assume it's all "normal."

The question is.....is a patient with controlled hypertension a glaucoma suspect? If so, what tests, if any should be ordered?
 
Let's assume it's all "normal."

The question is.....is a patient with controlled hypertension a glaucoma suspect? If so, what tests, if any should be ordered?
Yes they are a suspect, all patients are. But there level of suspicion is low. I don't think you can medically justify any glaucoma testing unless you notice a change or have something suspicious. If I did any testing it would be an OCT of the GCC and RNFL.
 
Let's assume it's all "normal."

The question is.....is a patient with controlled hypertension a glaucoma suspect? If so, what tests, if any should be ordered?

no, and that is not what the op was alluding to at all
 
New patient comes to your office. 55wm. He’s being treated for hypertension and reports it’s controlled well. BP in office is 120/80.

Cd is 0.3 OU.

Is this patient a glaucoma suspect?

If so....what tests do you order?

again...no, not what is being discussed here
 
SOP for many glaucoma cases is to limit the use of BP meds before bedtime, especially bblockers.